Presentation (CTI)

OBJECTIVES: Amidst the accelerating global demographic shift towards aging populations, establishing age-friendly community environments and optimizing health management systems have become crucial strategies for safeguarding public health. While existing research highlights the associations between environmental factors and cardiovascular diseases, evidence gaps persist regarding insufficient longitudinal evidence constraining causal inference, unquantified health disparities in vulnerable populations, and underexplored mediators. This study employs a comprehensive analysis on nationwide data to investigate the role of social isolation, cognition and depression in the relationship between age-friendly community environment and cardiovascular comorbidities among older adults, providing insights for designing integrated ageing care interventions.
METHODS: This prospective cohort study utilized national data from the China Health and Retirement Longitudinal Study (CHARLS), tracking 6,466 participants across 307 communities over a 10-year period (2011-2020). All incident data were patient-reported outcomes. Employing four-way decomposition analysis, this study examined the roles of social isolation, cognitive function, and depressive symptoms in linking age-friendly community environments to cardiovascular multimorbidity.
RESULTS: The age-friendly community environment scale (range from 0-10) demonstrated an average composite score of 4.96 across five evaluated domains. During the decade, a total of 447 incident cardiovascular multimorbidity cases were identified. While age-friendly environments retained a controlled direct effect, the four-way decomposition framework revealed depressive symptoms as the sole significant mediator, accounting for 13.43% of the total effect through pure natural indirect effects, with the excess relative risk (95% confidence interval) of -0.013 (-0.020, -0.005).
CONCLUSIONS: The mediation analysis identified depression as a statistically significant mediator linking age-friendly communities to reduced cardiovascular multimorbidity, suggesting prioritized integration of mental health screening and interventions in age-friendly policies, thus alleviating the societal burden of cardiovascular multimorbidity.